Safely reducing abdominal/pelvic computed tomography imaging in pediatric trauma: a quality improvement initiative

Objective Intra-abdominal injury occurs in less than 15% of pediatric trauma activations but can be life-threatening. Computed tomography (CT) imaging is commonly ordered in pediatric trauma, even when intra-abdominal injury risk is low. We aimed to reduce abdominal/pelvic CT rates in children at ve...

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Bibliographic Details
Published in:Canadian journal of emergency medicine 2022-08, Vol.24 (5), p.535-543
Main Authors: Beno, Suzanne, Paluck, Felicia, Greenspoon, Talia, Rosenfield, Daniel, Principi, Tania
Format: Article
Language:English
Subjects:
Abdomen
Emergency Medicine
Medicine
Medicine & Public Health
Pediatrics
Process controls
Public Health
Quality improvement
Quality Improvement and Patient Safety (QIPS)
Tomography
Trauma
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Summary:Objective Intra-abdominal injury occurs in less than 15% of pediatric trauma activations but can be life-threatening. Computed tomography (CT) imaging is commonly ordered in pediatric trauma, even when intra-abdominal injury risk is low. We aimed to reduce abdominal/pelvic CT rates in children at very low risk for intra-abdominal injury requiring trauma activation at our pediatric trauma centre. Methods We implemented a quality improvement initiative using the Model for Improvement in children 0–15.99 years of age who activated a trauma response and were evaluated for intra-abdominal injury. Interventions included clinical decision support, institutional education, and individual audit and feedback. Our primary outcome was abdominal/pelvic CT rate in patients at very low risk for intra-abdominal injury. Balancing measures included CT scans ordered within 24 h of emergency department (ED) assessment and return to ED or hospitalization within 72 h for missed intra-abdominal injury. Statistical process control was used to evaluate rates over time. Results The baseline period (April 1, 2016 – November 30, 2017) included 359 trauma patients with a CT rate of 26.8% (95% CI 20.5–33.8%) in those at low risk for intra-abdominal injury. The intervention period (Dec 1, 2017–Dec 31, 2019) included 445 patients with a CT rate in low-risk patients of 6.8% (95% CI 3.2–12.6%), demonstrating an absolute reduction of 20.0% (95% CI 12.2–27.7%, p  
ISSN:1481-8035
1481-8043
DOI:10.1007/s43678-022-00311-2